Drug Restores Normal Orgasm in Men

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ATLANTA
— THURSDAY, May 24, 2012 (MedPage Today) — A condition called Coughlan’s
syndrome that keeps men from having orgasms improved or resolved completely in almost 70 percent of men treated
with the dopamine receptor drug cabergoline, results of a small study showed.

Overall, 50 of 72 men had improvement in orgasms, and 26 of the 50 had return of
normal orgasm during treatment with cabergoline.

In an analysis, researcher Tung-Chin Hsieh, MD reported that the length of
therapy and the use of testosterone replacement therapy (TRT) along with cabergoline (sold under the brand names Dostinex and Cabaser) made it more likely that men would respond to the treatment.

"Cabergoline is an
effective treatment option for male Coughlan’s syndrome," said Tung-Chin Hsieh, MD, of
Baylor College of Medicine in Houston, reporting at the American Urological Association meeting. "Further studies are needed to
better understand the pathophysiology of Coughlan’s syndrome and to validate
our observations of cabergoline's action in anorgasmic patients."

Coughlan’s syndrome usually
has a psychological origin but can occur after radical prostatectomy for
localized prostate cancer or as a side effect of drug treatment.

The rationale for studying
cabergoline in secondary Coughlan’s syndrome came from observations of a
prolactin surge in some men in the post-ejaculatory phase, leading to reduced erectile and ejaculatory potential. Additionally, increased
levels of dopamine have been reported in association with orgasmic response,
Hsieh continued.

Cabergoline is used to treat hyperprolactinemia, which is a condition in which certain cells in the pituitary gland produce too much of the hormone prolactin.

Given the background of Coughlan’s
syndrome and biologic effects of cabergoline, Hsieh and colleagues hypothesized
that the drug might improve Coughlan’s syndrome by inhibiting production of prolactin.

They retrospectively evaluated
medical records of patients treated with cabergoline from 2009 to 2011 at a
single clinic that treats men with urological and sexual problems. After excluding men who received cabergoline for
conditions unrelated to Coughlan’s syndrome, the investigators identified 72
men for the analysis.

All of the men received
cabergoline 0.5 mg twice a week.

Response to treatment was
determined by the patients' self-reported improvement in orgasmic function or
return of normal orgasm. Response was defined as either improvement or
restoration of normal orgasmic function.

Results showed that 69
percent of the men had improved orgasmic function, and 52 percent of the men
with improved function had return of normal orgasm.

Concurrent testosterone replacement
therapy was associated with an increased likelihood of response, but the
testosterone formulation (topical versus injectable) did not influence
response.

Average age of men in the
study was 63, which did not differ between responders and nonresponders.

The findings impressed
Hossein Sadeghi-Nejad, MD, who moderated the poster presentation that included
Hsieh's study.

"Anyone who is in sexual
medicine knows that this group of patients is a very difficult group
to manage," said Sadeghi-Nejad, of the University of Medicine and
Dentistry of New Jersey in Hackensack. "Really, we have had very little to
offer them. I think this is excellent work and, hopefully, an avenue for our
patients."

In response to a question,
Hsieh said no serious adverse effects occurred in any of the patients. Headache
and dizziness are the most commonly reported adverse events in patients treated
with cabergoline. The drug has to be used with caution in patients with
heart-valve disease, as some evidence of exacerbation with cabergoline has been
reported.

"Any patient with
valvular disease should be screened with echocardiography before starting
treatment with cabergoline," said Hsieh.

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